Trauma expert: Nepal sites not prepared for emergencies

Prof. Avi Rivkind knew from his medical books what to do when he arrived at the American hospital in Kathmandu.

By JUDY SIEGEL-ITZKOVICH
People gather near a helicopter belonging to Nepal Army used to rescue avalanche victims at Thorang-La in Annapurna Region (photo credit: REUTERS)
People gather near a helicopter belonging to Nepal Army used to rescue avalanche victims at Thorang-La in Annapurna Region
(photo credit: REUTERS)
After decades of treating thousands of trauma victims in Jerusalem and flying abroad to help victims of terrorist attacks, earthquakes, floods and other catastrophes, it was Prof. Avi Rivkind’s first encounter with avalanche survivors suffering from severe frostbite.
But Rivkind, head of Hadassah University Medical Center’s trauma and urgent care branch in Jerusalem’s Ein Kerem, knew from his medical books what to do when he arrived at the American hospital in Kathmandu.
“I have treated hypothermia in survivors of terrorist attacks and fires, but not severe frostbite,” Rivkind told The Jerusalem Post after returning from his weekend experience with the Israelis who survived the snow and ice that took the lives of at least three of their friends.
Leaving at 2:30 a.m. on Saturday and returning to Israel from Kathmandu some 14 hours later, Rivkind saw only Israeli survivors, not other victims of the tragedy, or the three Israelis who are known to have died. There were five with severe or moderate frostbite of their fingers and/or toes, and one young woman who had been injured in the eye. Three arrived at Hadassah on Sunday, one with serious frostbite in the recovery room after receiving infusions, and the other two in the plastic surgery department.
“They were glad to see us after going through a terrible, unbelievable experience,” Rivkind recalled. “They will have to get intensive psychological treatment to prevent them from developing post-traumatic stress. We have experts at Hadassah to help them.” They will also be seen by orthopedists, plastic surgeons, general surgeons, scanning experts and others, he said.
Originally, the injured were taken to a local hospital, but their treatment was not optimal. “Their hands were washed, and they were given food. Only when they were transferred the next day to an American hospital were they given better treatment, including the infusion of a drug called Iloprost, which contains prostaglandins and expands the capillaries in the extremities, allowing more warm blood to reach the cold fingers and toes,” he said.
“But hours of critical time were wasted. The rewarming must be done in warm water at a temperature of about 38 degrees Celsius, placed in a plastic – not metal – container so that they aren’t burnt.” He would not say whether any extremities would have to be amputated.
Rivkind had brought with him from Jerusalem not only the intravenous vasodilating drug, as well as pain relievers and bandages with aloe vera, just in case – plus a Shabbat halla that he spontaneously wrapped and put in his baggage because he thought the Israeli young people would appreciate it. “They really did; they made a blessing on it, and the bread brought them a bit of home.”
It was the well-traveled Rivkind’s first visit to Nepal. Trekking in such a dangerous place, he said, never interested him, nor did it attract his children. “One shouldn’t go there. I ask every Jewish mother of every kind to tell their children not to go. If they really insist, the treks should be better organized, with heating, warm drinks and organized telecommunication so they will always be in touch with their families. These are my suggestions,” he said.
On the mountain where the avalanche occurred, all of these were lacking.
“There needs to be an operations room, organized by the Nepali government, for dealing with any emergency among foreigners. Israel’s diplomats cannot do this. It doesn’t have to be an avalanche. One can break a leg and need help. This place is full of Israelis; you hear Hebrew in the streets everywhere.”
Some of the Israeli trekkers he met, both those who were injured and those who were not involved in the catastrophe, told him they would never return to Nepal again, while others insisted they would despite what happened. “I heard stories here of real bravery, of a girl who took off her clothes to warm her friends,” he said.


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